Why a personalized approach is key to prolapse and OAB management

When evaluating a patient for pelvic organ prolapse and weighing what treatment course to recommend, Anna Myers, CNP, highlighted the importance of taking into account the patient’s symptoms.

“Did they come to me because they're in hydronephrosis, their kidney function is going down the drain, and they're not able to empty their bladder? That’s a patient [in whom] we're going to have to immediately intervene. They're going to need a pessary, surgery, maybe both, so we can get things taken care of. If it's a patient who comes in and it was just incidentally noted that they had a prolapse, per se on an exam, but they're not having any symptoms—there are no bladder symptoms, like frequency, urgency, leakage; they're not having frequent urinary tract infections; they’re able to empty their bladder, they're not having any pain—then we can monitor. Everybody else is sort of somewhere in between there,” said Myers, a certified nurse practitioner with University Hospitals in Cleveland, Ohio.

In a recent video interview with Urology Times®, Myers also touched on how she tailors management of overactive bladder (OAB) in her practice.

“What's really cool about overactive bladder is that, it's not like high blood pressure. They do not have to leave this office with a pill in hand. I can really get to know the patient, really hear [from] them [about] what else is going on in their life. Are they already taking a lot of medications and they don't want another medication?...Will they follow my lead on behavioral modifications?...Will they attend pelvic floor physical therapy? Do they even have a ride to get to pelvic floor physical therapy? And would they do the exercises?” Myers said.

Myers also highlighted the number of third-line interventions available for OAB.

“Our third-line options are terrific. Neuromodulation has been around for about 25, 30 years, and it has gotten so much better in the past 5 years. Now, the devices are MRI compatible. Battery life is 15 to 20 years. We also have Botox, which now people feel very comfortable with…And then we also have the percutaneous tibial [nerve stimulation]. I've done that since around 2015-16, and it's been out longer than that. But now we have, more recently, an implantable device, which we're doing a study on here at UH, and eventually, that'll be something that people can even [have implanted] in the office,” Myers said.